Training will Cover • OHP Standard Reservation List outreach and public awareness • The process for getting on the Standard Reservation List • Branch responsibilities for updating the Reservation List Web Site • The application process, including adding DOR to Web Site
OHP Standard Reservation List • In January of 2008 the OHP Standard Reservation List first opened • People were selected by a random process and received an application to apply for OHP-OPU • The Reservation List officially reopened November 1, 2009
OHP Standard Reservation List Overview • The reservation list is for persons who would otherwise be denied because OHP Standard is closed • A designated number of applications will be sent out periodically until OHP Standard reaches a limit determined by the Division of Medical Assistance Programs (DMAP)
Remember Clients transitioning from other DHS medical programs may still be eligible for OHP Standard following our current policy
Non-citizens The reservation list is for citizens and non-citizens, including those who may be eligible for Citizen/Alien-Waived Emergent Medical (CAWEM)
Public Outreach and Awareness DHS began an outreach and awareness campaign throughout the state in November 2009 which included: • Posters • Press releases • OHP Web page • Flyers
Everyone Has the Right to Know About the Reservation List Give applicants for medical benefits information about the OHP Standard Reservation List including: • The OHP Standard reservation list request form (OHP 3203) • Other options available for adding their name to the Reservation List
When People Ask About the Reservation List • The Reservation List is open • People interested in applying for OHP Standard need to add their name to the Reservation List • Confirmation letters will be mailed every Wednesday to people who are added to the Reservation List during the prior week
Who can request an OHP Standard reservation? A person can request a reservation number for him/herself or the request may be made with the client’s consent by: • Health practitioners • DMAP Outreach workers • Community advocates • Family members and friends
DHS/AAA Staff Cannot Request a Reservation for an Applicant • To ensure equality, DHS/AAA staff may not request an OHP Standard reservation for their clients • However, DHS/AAA staff should offer to assist a person with the process to complete their request • Closure and denial notices have been updated to include reservation list information
One Way a Person Gets on the List • Request electronically via the public OHP Standard Reservation List Web Site: www.oregon.gov/DHS/open
Entering Reservation List Requests On the Public Web Site • Requests entered on the public Web Site will download automatically to the DHS Database • Using the Web Site on-line has advantages for requesters, including being able to add a request around the clock from any computer with access to the Web.
Other Ways a Person Can Get on the List • Call the Reservation List Phone Bank Monday through Friday from 7:00 AM to 6:00 PM • 1-800-699-9075 • TTY 711 • Complete an OHP Standard reservation list requestform (OHP 3203) and submit by • Mail to OHP Standard, PO Box 14520, Salem, OR 97309-5044 • Fax to 503-373-7866 or 503-378-6295 • Dropping it off at any DHS/AAA office
Information Required for the OHP Standard Reservation List • Full name • Date of birth • Mailing address • Phone number (voluntary) • SSN (voluntary)
Alternate Formats and Languages Reservation List Materials can be requested in other formats such as Braille, audio tape, large print, computer disk, oral presentation, and in languages other than English Optimal Phone Interpreters: 1-877-746-4674
Reminder About Sending the Reservation Request Form to 5503 Please do not send the paper OHP 3203 if you have already sent the information by another method, fax, scan, e-mail GroupWise address (Reservation,Standard)
The OHP Standard Reservation is Not an Application Persons who add their name to the Reservation List need to know: • They have not applied for any medical benefits • They have not qualified for any kind of OHP coverage
If Requesters Ask When They’ll Get an OHP Standard Application • Only those selected from the Reservation List will be mailed a 7210R • They may not need to submit the 7210R if they already have DHS program benefits • They must establish a DOR within 45 days from the date the 7210R is mailed • To establish a DOR, they can call or leave a note (or submit an application). DHS will determine if anyone on the application is eligible and will send approval/denial notices
Everyone Has the Right to Applyfor Medical Benefits • Only OHP Standard is closed • Each medical program has different eligibility requirements • Applicants may qualify for another medical program
The DHS OHP Standard Reservation List Web Site • The Web Site is where staff can search for reservation information and also see if the client has been selected • The Web Site allows us to edit reservations for address and other changes • The Web Site is used for the random selection process • The Web Site stores the DOR and gathers statistics about Reservation List outcomes
Random Selection • The number of reservations randomly selected will be predetermined by DMAP • People selected will receive a confirmation letter with a reservation number and the option to provide a third party contact (branches will need to add third party contacts or forward them to 5503)
Third Party Contacts • Third party contacts will be able to assist requesters with their application • Third party contacts will receive notification of 7210R and other requester mailings • Third party contacts are not authorized representatives
7210R Mailed • Persons selected from the reservation list will be mailed a 7210R • The 7210R mailing does not establish a DOR • The 7210R packet includes a return envelope to the local office if a companion case exists
Date of Request Overview • OHP 7210R recipientswill have 45 days from the mailing date to establish their DOR • DOR is established when they return their application or contact a DHS/AAA branch stating they want medical • 7210R cover letter will explain the application and DOR process
DOR Time Frames • Applicants who have been mailed a selection letter will receive the 7210R, however they can submit a 415F, 7210, 7210W, or 539A • DOR is established by calling, leaving a note or submitting a 7210R or other application • If a DOR is not established within 45 days from the date the 7210R is mailed the reservation is no longer valid • The SPD/AAA/SSP office that receives the client’s DOR is responsible for adding it to the Reservation Website
7210R Applicant Receiving DHS Benefits A completed 7210R application is not required Example: John and Sue are receiving SNAP benefits. Their reservation number was selected and they were mailed a 7210R. They can establish a DOR by contacting a branch office, and the worker can use the application on file to determine eligibility.
Application Process Overview • SPD/AAA offices will determine eligibility for clients age 60 and above. • If an SSP office receives an application for an individual age 60 and above, date stamp the application, update the Reservation Web Site and forward to the local SPD/AAA office
5503 Process Overview • If a companion case exists, 5503 will forward the application to the local SSP office • 5503 will forward applications for clients age 60 and above to the local SPD office • 5503 will also update the Reservation Web Site and narrate before forwarding the application
Emergent Medical Need • Follow office procedure for emergent medical requests • Remember to update the Reservation List Web Site
Replacing a Lost 7210R • Look up the person in the OHP Standard Reservation List Web Site • Write the reservation # on a new application (415F, 7210, 7210R or 539A ) • Give the requester the date stamped application to establish their DOR and remind them to return it within 45 days • Update the Web Site with the DOR if the DOR has not been updated • Narrate in TRACS or ACCESS
How to Find a Reservation Note: Enter dates and social security numbers as shown.
Identifying Current Reservations Notice which round the Reservation is in. Clients with Reservations from the first round are not included in the random selection and are not updated. Ignore round 1 Reservations. (They will be removed later).
Checking Selections from the Reservation List Click Reservationwide Info to see the Random Selection Date. Note the Random Selection Date if there is one.
Updating the Reservation Web Site • Each DHS/AAA office is responsible for updating some items on the Web Site • Staff will need to update the requester’s information: • Race • Ethnicity • How the client heard • about the Oregon • Standard Reservation • List (OSRL) • Language • Changes to 3rd Party • Contact • Adding an adult to an • existing reservation
Local Office Action: Updating the Standard Reservation List Web Site Staff will need to update the application processing information: • DOR • Why the application was pended or denied or • What program was approved • Address change • Transfer of application information must be completed (branch, worker id, etc) • Worker ID • Branch
Example of Local Office Action: Requester Address Change If a reservation list requester reports an address change, the worker or support staff are responsible to update the address: • Access the Reservation List Web Site and update the information
Another Example of a Local Office Action: Screen Print for Race and Ethnicity
Adding a Person to the Reservation • Only 5503 can add new Reservations • Local DHS/AAA offices can add adults to existing Reservations Example: Jane S reports she married John Doe • Check the Reservation Web Site. If Jane S has a Reservation, add John Doe to her reservation
Example for Adding a Person To add a person to a reservation click on the Person 2 tab and complete the requested information.
Local Office Action • Check the Web Site and if the DOR is not updated, enter it • Add the worker ID and the branch number • Update the pending, approved, or denied reason • Narrate on TRACS or ACCESS
How will ADA accommodations be provided? Accommodations may be made for persons with a documented disability who: • Did not get their name on the reservation list • Did not establish a DOR within 45 days • Did not complete an application within 45 days of their DOR Contact an SSP medical policy analyst who will determine if a person qualifies for an ADA accommodation
The 7210R Can be Used for Non-Standard Applicants Workers can use the 7210R to review eligibility for the whole family
Who May Share the Same Reservation Number? • Adults in the OHP filing group when the reservation was added or when the application is submitted • Adults in the OHP filing group who leave the household after the reservation was added • Adults in the OHP filing group who enter the household after the reservation was added • Children in the OHP filing group who have become adults (turned 19) since the reservation was added
Processing the 7210R (or other application) For New Applicants on an Open Medical Case • Determine eligibility for everyone on the case • If eligible for any medical program, recertify the entire case and begin the applicant’s medical coverage on the new DOR • If the applicant is not eligible, send a denial notice stating specifically why and a 462A/462C/462S notice. Allow the rest of the family to continue their certification period.
Using the Same Reservation List Number for Two Different CM Cases The reservation number applies to anyone in the filing group at the time the reservation was made and any new additions to the filing group Let’s look at some examples: